B74-11 A Descriptive Analysis of the Effects of Pulmonary Rehabilitation on Patients With Diaphragm Paralysis

Rationale Diaphragm hemiparalysis or paresis is a rare but life-debilitating cause of dyspnea that often goes underdiagnosed and undertreated in patients who have disruption of their diaphragm innervation or muscular function secondary to trauma, myopathies, neuropathies, or mechanical ventilation. The hallmark of therapy for diaphragm paralysis includes diaphragm plication and phrenic nerve pacing/reconstruction. While surgical interventions have demonstrated benefit in increasing pulmonary function, these procedures increase the risk of infection, bleeding, arrhythmias, and have variable long-term benefits when it comes to addressing patient’s dyspnea concerns. Pulmonary rehabilitation (PR) is a multidisciplinary treatment modality that has demonstrated modest improvement in various metrics of exercise capacity, dyspnea, and quality of life in patients with chronic lung disease, although understudied in diaphragm hemiparalysis. This descriptive analysis describes the effect of pulmonary rehabilitation on patients with diaphragm paralysis, with intention to shape future research on treatment for the condition. Methods Patients referred to University of Vermont Medical Center PR for diaphragm hemiparalysis, paresis, or dysfunction from 2009-2025 were isolated. Demographic data, program completion, and pulmonary function testing, in addition to pre- and post-program measurements of modified medical research council (mMRC) dyspnea scale, 6-minute walk test (6MWT), St. George Respiratory Questionnaire, Borg, Patient Health Questionnaire-9 (PHQ-9), and chair and gait speed. A pair t- test of the data was completed on Microsoft Excel. Results Ten patients were enrolled in PR at UVMMC from 2009 to October 2025. On average, patients attended 89% of PR sessions, with 100% completion. The most profound benefit observed at the end of the 8-week program was distance during the 6MWT; patients had an improvement of 175 +/- 236 ft (p = 0.046). Patients also demonstrated a decrease in the Borg dyspnea score (1.3 +/- 1.06 points, p = 0.0048). Conclusion Patients demonstrated significant improvement in exercise capacity as demonstrated by their increase in their 6MWT and Borg score at rest, with other measured metrics remaining constant. Results demonstrate that patients with diaphragm paralysis do gain significant benefits in their cardiopulmonary fitness and subjective dyspnea, even a short course of structured pulmonary exercise. Lifestyle interventions such as PR would have to be studied in larger subsets to gain a more comprehensive understanding of its effects on quality of life and depression.